Joint Learning Network for Universal Health Coverage

Provider Payment systems serve as a backbone to successful insurance platforms. A well designed provider payment system enables good quality of care, timely provision of services, prevention of fraud, and effective cost management. The development of robust provider payment systems that meet these objectives is a complex process that requires significant data, sophisticated infrastructure, and harmonization of policy. The opportunities and challenges inherent in the design and implementation of provider payment systems make it a key area of interest for the Joint Learning Network countries.

At the pilot Joint Learning Workshop that was held in India in February, 2010, provider payment was one of four technical track topics that participants could elect to attend. In subsequent feedback from country delegates, a deeper-dive workshop on provider payment models was one of the most requested follow-up activities. Delegates were most interested in more in-depth studies of the different provider payment models available, and in learning the methodology behind capitation and DRGs. Additionally, delegates expressed the need for tools and assistance in developing action plans for implementation or reform of these models, and support for how to manage challenges such as creating the necessary political will for reform, harmonizing disparate systems, and controlling costs.